Yes, you can choose my own doctor in Wisconsin’s Worker’s Compensation Act (WCA or the Act) provides that an injured employee is entitled to unlimited medical, surgical, chiropractic, psychological, podiatric, dental, and hospital treatment (including treatment by physician assistants and advanced practice nurse prescribers), as well as artificial members and appliances, “as may be reasonably required to cure and relieve from the effects of the injury.” Wis. Stat. § 102.42(1). If the employer/insurer disputes the treatment, its need must be proved by expert medical testimony. Wisconsin Tel. Co. v. Industrial Comm’n, 263 Wis. 380, 57 N.W.2d 334 (1953). Under Wis. Stat. § 102.42 , the injured employer’s choices include every practitioner “licensed to practice and practicing in the state.” There is an automatic second choice, but no third choice or choice of an out-of-state practitioner, except with the employer’s consent. Wis. Stat. § 102.42(2) . Partners and clinics count as one practitioner, and referrals to other practitioners do not count as additional choices. We advise injured workers to get referrals from the initial choice and each subsequent doctor under that first choice so that the second choice is always available for the worker to choose my own doctor.
The insurance carrier is also responsible for reasonable and necessary treatment “to prevent further deterioration in the condition of the employee or to maintain the existing status of such condition whether or not healing is completed.” Wis. Stat. § 102.42(1) . This responsibility does not end with the final payment of disability benefits but is subject to Wis. Stat. § 102.17(4), 12 years from the last payment of compensation for occupational disease or, in the case of traumatic injury, after 6 years from the last payment of compensation. Liability for medical bills generally does not cease with a final order but is subject only to the statute of limitations. Wis. Stat. § 102.17(4); Lisney v. LIRC, 171 Wis. 2d 499 , 493 N.W.2d 14 (1992) . Liability for future medical expenses can be extinguished by a full and final compromise approved by the Department of Workforce Development (DWD, or the department). Schenkoski v. LIRC, 203 Wis. 2d 109 , 552 N.W.2d 120 (Ct. App. 1996) .
Medical expenses paid under a health insurance policy, which almost always have a worker’s compensation exclusion, the administrative law judge will almost always order reimbursement if liability against the worker’s compensation insurance carrier is later found at hearing. See Wis. Stat. § 102.30(7)(a). We also take health insurance subrogation liens into consideration in any compromise or settlements depending on the facts. Choose my own doctor is the law in Wisconsin.
McCormick Law Office in Milwaukee, Wisconsin.
